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Yoon HY, Ryu JS, Sim YS, Kim D, Lee SY, Choi J, Park S, Ryu YJ, Lee JH, Chang JH. Clinical significance of EGFR mutation types in lung adenocarcinoma: A multi-centre Korean study. PLoS One 2020; 15:e0228925. [PMID: 32053675 PMCID: PMC7018076 DOI: 10.1371/journal.pone.0228925] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/26/2020] [Indexed: 01/09/2023] Open
Abstract
Adenocarcinoma is the most common type of non-small cell lung cancer. Some causative genomic alterations in epidermal growth factor receptor (EGFR), including deletions in exon 19 (E19 dels) and a point mutation in E21, are known to have favourable prognoses due to sensitivity to tyrosine kinase inhibitors; however, the prognoses of other uncommon mutations are unclear. This study analysed the clinical significance of EGFR mutation types in lung adenocarcinoma. We retrospectively reviewed 1,020 subjects (mean age: 66.8 years, female: 41.7%) who were diagnosed with advanced lung adenocarcinoma, had EGFR mutation data, and did not undergo surgery from five medical institutes between 2010 and 2016. Subjects were classified according to EGFR mutation status, particularly for exon-specific mutations. EGFR positivity was defined as the presence of mutation and EGFR negativity was defined as wild-type EGFR. EGFR positivity was 38.0%, with the incidence of mutations in E18, E19, E20, and E21 was 3.6%, 51.0%, 3.4%, and 42.0%, respectively. The EGFR positive group survived significantly longer than the negative group (p<0.001), and there was a significant difference in survival among the four EGFR mutation sites (p = 0.003); E19 dels were the only significant factor that lowered mortality (HR: 0.678, p = 0.002), while an E21 mutation was the prognostic factor associated with the most increased mortality (HR: 1.365, p = 0.015). Amongst EGFR positive subjects, the proportion of E19 dels in TKI-responders was significantly higher and that of E21 mutations significantly lower, compared with non-responders. In TKI treatment, mutations in E18 and E20 were not worse factors than the E21 L858R mutation. In conclusion, the presence of EGFR mutations in advanced lung adenocarcinoma can predict a good prognosis; E19 dels prospect to have a better prognosis than other mutations, while an E21 mutation is expected to increase mortality.
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Affiliation(s)
- Hee-Young Yoon
- Division of Pulmonary and Critical Care Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jeong-Seon Ryu
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
- * E-mail: (JSR); (YSS); (DK); (SYL); (JHC)
| | - Yun Su Sim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
- * E-mail: (JSR); (YSS); (DK); (SYL); (JHC)
| | - Dojin Kim
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi, Republic of Korea
- * E-mail: (JSR); (YSS); (DK); (SYL); (JHC)
| | - Sung Yong Lee
- Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
- * E-mail: (JSR); (YSS); (DK); (SYL); (JHC)
| | - Juwhan Choi
- Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Sojung Park
- Division of Pulmonary and Critical Care Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Yon Ju Ryu
- Division of Pulmonary and Critical Care Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jung Hyun Chang
- Division of Pulmonary and Critical Care Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- * E-mail: (JSR); (YSS); (DK); (SYL); (JHC)
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Han JY, Lee HT, Oh SY. EGFR Analysis in Cytologic Samples of Lung Adenocarcinoma by Microdissection. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2015. [DOI: 10.15324/kjcls.2015.47.3.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jeong Yeon Han
- Department of Pathology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hoon Taek Lee
- Department of Animal Biotechnology, College of Animal Bioscience & Technology, Konkuk University, Seoul 05029, Korea
| | - Seo Young Oh
- Department of Pathology, Konkuk University Medical Center, Seoul 05030, Korea
- Department of Animal Biotechnology, College of Animal Bioscience & Technology, Konkuk University, Seoul 05029, Korea
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Oh SY, Lee HT. Efficiency of EGFR mutation analysis for small microdissected cytological specimens using multitech DNA extraction solution. Cancer Cytopathol 2015; 123:401-12. [PMID: 25964184 DOI: 10.1002/cncy.21550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/23/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The microdissection method has greatly facilitated the isolation of pure cell populations for accurate analysis of mutations. However, the absence of coverslips in these preparations leads to poor resolution of cellular morphological features. In the current study, the authors developed the MultiTech DNA extraction solution to improve the visualization of cell morphology for microdissection and tested it for the preservation of morphological properties of cells, quality of DNA, and ability to detect mutations. METHODS A total of 121 cytological samples, including fine-needle aspirates, sputum, pleural fluid, and bronchial washings, were selected from hospital archives. DNA extracted from microdissected cells was evaluated by epidermal growth factor receptor (EGFR) mutation analysis using pyrosequencing, Sanger sequencing, and peptide nucleic acid (PNA)-mediated real-time polymerase chain reaction clamping. Morphological features of cells as well as DNA quality and quantity were analyzed in several cytological samples to assess the performance of the MultiTech DNA extraction solution. The results were compared with previous EGFR mutation tests. RESULTS The MultiTech DNA extraction solution improved the morphology of archived stained cells before microdissection and provided a higher DNA yield than the commercial QIAamp DNA Mini Kit in samples containing a minimal number of cells (25-50 cells). The authors were able to detect identical EGFR mutations by using different analysis platforms and consistently identified these mutations in samples comprising as few as 25 microdissected cells. CONCLUSIONS The MultiTech DNA extraction solution is a reliable medium that improves the resolution of cell morphology during microdissection. It was particularly useful in EGFR mutations of samples containing a small number of cells.
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Affiliation(s)
- Seo Young Oh
- Department of Animal Biotechnology, College of Animal Bioscience and Technology, Konkuk University, Seoul, Korea
| | - Hoon Taek Lee
- Department of Animal Biotechnology, College of Animal Bioscience and Technology, Konkuk University, Seoul, Korea
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Oh SY, Han JY, Lee SR, Lee HT. Improved DNA Extraction Method for Molecular Diagnosis from Smaller numbers of Cells. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2014. [DOI: 10.15324/kjcls.2014.46.3.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seo Young Oh
- Department of Pathology, Konkuk University Medical Center, Seoul 143-729, Korea
- Department of Animal Biotechnology, College of Animal Bioscience & Technology Konkuk University, Seoul 143-701, Korea
| | - Jeong Yeon Han
- Department of Pathology, Seoul National University Hospital, Seoul 110-744, Korea
| | - So Ra Lee
- Department of Pathology, Konkuk University Medical Center, Seoul 143-729, Korea
| | - Hoon Taek Lee
- Department of Animal Biotechnology, College of Animal Bioscience & Technology Konkuk University, Seoul 143-701, Korea
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Oh SY, Kim WY, Hwang TS, Han HS, Lim SD, Kim WS. Development of an ammonium sulfate DNA extraction method for obtaining amplifiable DNA in a small number of cells and its application to clinical specimens. BIOMED RESEARCH INTERNATIONAL 2013; 2013:546727. [PMID: 23691506 PMCID: PMC3652119 DOI: 10.1155/2013/546727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 11/17/2022]
Abstract
DNA extraction from microdissected cells has become essential for handling clinical specimens with advances in molecular pathology. Conventional methods have limitations for extracting amplifiable DNA from specimens containing a small number of cells. We developed an ammonium sulfate DNA extraction method (A) and compared it with two other methods (B and C). DNA quality and quantity, β-globin amplification, and detectability of two cancer associated gene mutations were evaluated. Method A showed the best DNA yield, particularly when the cell number was very low. Amplification of the β-globin gene using DNA from the SNU 790 cell line and papillary thyroid carcinoma (PTC) cells extracted with Method A demonstrated the strongest band. BRAF(V600E) mutation analysis using ethanol-fixed PTC cells from a patient demonstrated both a "T" peak increase and an adjacent "A" peak decrease when 25 and 50 cells were extracted, whereas mutant peaks were too low to be analyzed using the other two methods. EGFR mutation analysis using formalin-fixed paraffin-embedded lung cancer tissues demonstrated a mutant peak with Method A, whereas the mutant peak was undetectable with Methods B or C. Method A yielded the best DNA quantity and quality with outstanding efficiency, particularly when paucicellular specimens were used.
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Affiliation(s)
- Seo Young Oh
- Department of Animal Biotechnology, College of Animal Bioscience and Technology, Konkuk University, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Wook Youn Kim
- Department of Pathology, Konkuk University School of Medicine, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Tae Sook Hwang
- Department of Pathology, Konkuk University School of Medicine, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University School of Medicine, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - So Dug Lim
- Department of Pathology, Konkuk University School of Medicine, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University School of Medicine, 1 Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea
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Kim HJ, Lee KY, Kim YC, Kim KS, Lee SY, Jang TW, Lee MK, Shin KC, Lee GH, Lee JC, Lee JE, Kim SY. Detection and comparison of peptide nucleic acid-mediated real-time polymerase chain reaction clamping and direct gene sequencing for epidermal growth factor receptor mutations in patients with non-small cell lung cancer. Lung Cancer 2011; 75:321-5. [PMID: 21930325 DOI: 10.1016/j.lungcan.2011.08.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 06/29/2011] [Accepted: 08/13/2011] [Indexed: 10/17/2022]
Abstract
EGFR tyrosine kinase inhibitors (EGFR-TKIs) are recommended as first-line therapy in patients with advanced, recurrent, or metastatic non-squamous non-small cell lung cancer (NSCLC) that have active EGFR mutations. The importance of rapid and sensitive methods for the detection of EGFR mutations is emphasized. The aim of this study is to examine the EGFR mutational status by both direct DNA sequencing and peptide nucleic acid (PNA)-mediated real-time PCR clamping and to evaluate the correlation between the EGFR mutational status and the clinical response to EGFR-tyrosine kinase inhibitors. Clinical specimens from 240 NSCLC patients were analyzed for EGFR mutations in exons 18, 19, 20 and 21. All clinical data and tumor specimens were obtained from 8 centers of the Korean Molecular Lung Cancer Group (KMLCG). After genomic DNA was extracted from paraffin-embedded tissue specimens, we performed PNA-mediated real-time PCR clamping and direct DNA sequencing for the detection of EGFR mutations. Of 240 tumor samples, PNA-mediated PCR clamping was used to detect genomic alterations in 83 (34.6%) samples, including 61 identified by sequencing and 22 additional samples (10 in exon 19, 9 in exon 21, and 3 in both exons); direct DNA sequencing was used to identify a total of 63 (26.3%) mutations that contained 40 deletion mutations in exon 19 (63.5%) and 18 substitution mutations (28.6%) in exon 21. PNA-mediated PCR clamping was used to identify more mutations than clinical direct sequencing, whereas clinical outcomes were not significantly different between the groups harboring activating mutations detected by each method. These data suggest that PNA-mediated real-time PCR clamping exhibits high sensitivity and is a simple procedure relative to direct DNA sequencing that is a useful screening tool for the detection of EGFR mutations in clinical settings.
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Affiliation(s)
- Hee Joung Kim
- Department of Internal Medicine, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea
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Schmitt F, Barroca H. Possible use and role of molecular techniques in fine-needle aspiration cytology (FNAC) practice. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.mpdhp.2011.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Kim HJ, Kim WS, Shin KC, Lee GH, Kim MJ, Lee JE, Song KS, Kim SY, Lee KY. Comparative Analysis of Peptide Nucleic Acid (PNA)-Mediated Real-Time PCR Clamping and DNA Direct Sequencing for EGFR Mutation Detection. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.1.21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hee Joung Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Kyeong-Cheol Shin
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Gwan Ho Lee
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Mi-Jin Kim
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong Eun Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyu Sang Song
- Department of Pathology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Young Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kye Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Lee KY, Kim HJ, Kim SJ, Yoo GH, Kim WD, Oh SY, Kim WS. PNA-Mediated PCR Clamping for the Detection of EGFR Mutations in Non-Small Cell Lung Cancer. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.4.271] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kye Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hee Joung Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Jong Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Gwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Won Dong Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seo Young Oh
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
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